Bipolar mania triggers
9 Most Common Triggers for Bipolar Mood Episodes
Spats with your sweetheart, chilly weather, grief — a number of scenarios may provoke bipolar mania or depression.
By Madeline R. Vann, MPHMedically Reviewed by Kathryn Keegan, MD
Reviewed:
Medically Reviewed
Justin Case/Getty ImageBipolar disorder is characterized by symptoms including unusual shifts in mood and energy. These mood shifts or episodes last at least a week in the case of mania, and at least two weeks in the case of depression, according to psychiatrist Jeffrey Bennett, MD, an associate professor of psychiatry at the Southern Illinois University School of Medicine in Springfield.
There are several types of bipolar and related disorders. In order to be diagnosed with bipolar I, you must have had at least one manic episode that may have been preceded or followed by hypomanic or depressive episodes. In the case of bipolar II, you must have had at least one major depressive episode and at least one hypomanic episode, but never experienced a manic episode.
Both mania and hypomania share the same symptoms, which include feeling unusually upbeat, euphoric, or irritable, with increased energy, mood elevation, a decreased need for sleep, racing thoughts, trouble concentrating, and poor judgment. In cases of mania, these symptoms are severe enough to be causing significant problems in your day-to-day life.
For example, you might be unable to go to work or school, or you may be compulsively spending money. Hypomania is considered a less severe form of mania. In cases of hypomania, your daily functioning isn't significantly impacted. For example, you are able to work and socialize.
When mood shifts are severe enough, they can have a profound effect on your life. Some episodes of depression and mania are accompanied by loss of reality or psychosis, characterized by hallucinations or delusions. "And unfortunately, suicide is common, with some sources estimating it to be as high as 10 to 15 percent," explains Dr. Bennett.
Can these episodes be avoided? Perhaps not.
But understanding certain triggers can help you better manage bipolar disorder.
One of the most common bipolar triggers is stress. In a study published in June 2014 in the Journal of Affective Disorders, negative or stressful life events were associated with subsequent mood swings. Earlier in their course, episodes of depression or mania in bipolar disorder appear to be triggered more often by stressful life events.
In addition, with recurrent episodes, some people with bipolar disorder may experience less complete periods of remission and a greater likelihood of relapse, either to depression or mania, according to Bennett.
While causes of stress are highly individual, certain life events and lifestyle patterns may act as triggers. Watch out for these common culprits.
Changes in Sleep Patterns or Lack of Sleep
Getty ImagesA change in your sleep pattern is a hallmark symptom of bipolar disorder — but it can also be a trigger.
Shift workers, people who work long hours, and students who are short on sleep are all at risk for having a recurrence of a mood episode related to a lack of sleep.
"In addition, travel beyond one's time zone can be another trigger for a mood episode," says Bennett.
Interpersonal and social rhythms therapy (IPSRT) is one of the most effective preventions, Bennett says. This treatment approach, available in group as well as individual sessions, helps you develop an orderly life schedule of sleep, diet, and exercise habits, to make you more effective at managing bipolar disorder.
Other forms of therapy, including psychoeducation and cognitive-behavioral therapy (CBT), can also be helpful in managing the illness.
Blowout Arguments With Partners, Coworkers, or Friends
Paul Simcock/Getty ImagesBroken relationships are too often the result of untreated bipolar disorder.
But getting into a spat with a loved one could also be a red flag: Your argument could be due to the irritability that often occurs during a manic or depressive episode, or could itself cause stress that becomes a contributing factor for a recurrent episode.
Any type of relationship conflict — whether it’s with your partner, coworker, family member, or friend — can trigger stress and send you over the edge. In a study published in May 2015 in the Journal of Affective Disorders, people with bipolar disorder said negative social experiences were among the events that triggered suicidal thinking for them.
The Stress of a Bad Breakup or Failed Marriage
Getty ImagesA number of people with bipolar disorder — especially those with a history of severe manic episodes — have failed marriages. If you’re going through a divorce, working with your therapist through what is often a drawn-out and extremely stressful process can help.
You might consider a durable power of attorney that allows someone else to make major decisions for you, such as financial ones, when you are going through an episode of depression or mania in relation to or during a breakup.
In fact, assigning a durable power of attorney could be useful for anyone who might be experiencing an episode of bipolar disorder.
Alcohol Abuse and Drug Intoxication, and the Aftereffects
Ivan Kmit/AlamyAbusing drugs and alcohol doesn’t cause bipolar disorder, but it can cause an episode to suddenly occur, or it can worsen the underlying illness. What’s more, about one in five people with bipolar disorder have a substance abuse disorder, according to an analysis of data on young adults with mental illness from an article published in February 2015 in the journal Social Psychiatry and Psychiatric Epidemiology.
Intoxication with drugs such as cocaine and amphetamines can cause or worsen manic symptoms, while the aftereffects of cocaine or use of alcohol are associated with worsening of depressive symptoms.
Antidepressants, Corticosteroids, and Other Medication
Jeff Wasserman/StocksyCan antidepressants make you manic?
The treatment of bipolar disorder can trigger episodes of mania by further setting off unstable moods and behaviors. Many psychiatrists say they've seen patients enter a manic phase after starting antidepressants — and some feel uncomfortable prescribing them to bipolar patients.
What should you do about bipolar depression? Until more research is available on long-term safety, Keming Gao, MD, PhD, a professor of psychiatry at Case Western Reserve School of Medicine in Cleveland, suggests the following: For bipolar I depression, antidepressants should only be used with a mood stabilizer or stabilizers after symptoms haven't responded to FDA-approved treatment options (such as mood stabilizers).
Dr. Gao says that while some recent studies suggest that using an antidepressant alone is as effective as lithium taken alone for some bipolar II patients (those who haven't experienced a manic episode), they should never be used alone for bipolar I depression, and patients and doctors should consider discontinuing use of antidepressants once symptoms have responded.
Other drugs that have been linked to manic symptoms include corticosteroids, thyroid medication, and appetite suppressants.
A Brand-New Season and Abnormal 'Clock Genes'
Noelia Ramon/Getty ImagesAbout 20 percent of people with bipolar disorder experience fluctuations in mood when the weather changes.
Specifically, they're more likely to undergo seasonal depression during the early winter, and mania or hypomania during the spring or summer, according to a research review published in October 2014 in the Journal of Affective Disorders.
Experts chalk this up to sunlight: Your circadian rhythm, the body’s internal response to changes in a 24-hour day, is affected by the amount of sunlight you experience. This response is controlled by a complex set of genes commonly referred to as “clock genes.” If some of these genes are abnormal, you could be at risk for seasonal bipolar disorder.
A Visit From the Stork Along With Altered Sleep Patterns and Shifting Hormones
Catherine Delahaye/Getty ImagesThe American College of Obstetrics and Gynecology estimates that women with bipolar disorder have up to a 67 percent chance of experiencing an episode of bipolar disorder in the postpartum period — the weeks and months after birth.
Changing sleep patterns, altered medication prescriptions, and shifting hormones after delivery can combine to serve as risk factors for a postpartum mood or psychotic episode, according to research published in November 2014 in the journal The Lancet.
Use the nine months of pregnancy to work with your entire medical team — your bipolar disorder specialists and your ob-gyn — on treatment approaches you can try during and after pregnancy to help prevent postpartum depression, postpartum mania, or postpartum psychosis.
Bipolar disorder is also strongly associated with postpartum psychosis, a severe mental illness characterized by an inability to respond emotionally to one's newborn, or thoughts of harming one's baby.
Financial and Emotional Strains Due to a Job Loss
Audtakorn Sutarmjam/AlamyOne of life’s most unpredictable stressors? Losing your job.
And the emotions you may feel about your job loss can be equally unpredictable. People who weren’t satisfied with their work can find it liberating. For others, the financial and emotional strains involved can trigger major stress. Either way, the dramatic shift in emotions could trigger a bipolar episode.
It may be a good idea to put away three to six months of savings to help with the transition, should you lose your job.
The Death of a Loved One and Bereavement
Getty ImagesThe death of a loved one may be the most stressful life event any of us will ever face. Many people continue managing bipolar disorder successfully through their mourning, but it may have extreme consequences for others, who can develop “funeral mania,” says Bennett.
This occurs when someone with controlled bipolar disorder attends the funeral of the loved one and has a manic episode over the course of the following week. The period of bereavement should be one of increased monitoring and heightened support, advises Bennett.
Prevention of a bipolar mood episodes may not be possible, but understanding triggers may help you better manage your illness.
Bipolar Episode Triggers | Everyday Health
Bipolar disorder is a mental health condition that affects millions of people in the United States. According to the National Institute of Mental Health (NIMH), an estimated 4.4 percent of American adults experience bipolar disorder at some point.
The disorder, which can cause extreme shifts in mood, energy, activity levels, and the ability to think clearly, can affect individuals differently, and the severity and types of symptoms can vary from one person to another.
Although the exact cause of bipolar disorder is unknown, it is thought that several factors, such as genes, brain structure, and stress response and management, could play a role in how often symptoms occur, how severe they become, and how long they last, according to the National Alliance on Mental Illness (NAMI). Certain lifestyle and environmental factors can also trigger or aggravate the extreme highs and lows, known as bipolar episodes, which are a hallmark of the condition. Once you’re aware of these triggers, you can gain better control over your disorder.
Types of Bipolar EpisodesThe main difference between bipolar disorder and conditions such as depression is the possibility of experiencing the overly excited state called mania, says Amit Anand, MD, a professor of medicine at the Lerner College of Medicine, vice-chair for research for the Center for Behavioral Health, and the director of the Mood and Emotional Disorders Across the Life Span program, all at the Cleveland Clinic in Ohio.
People who are manic are unusually outgoing or happy. In some cases, mania also causes intense irritability and restlessness. During depressive episodes, intense sadness or hopelessness may lead to fatigue, trouble concentrating, and thoughts of suicide.
But bipolar mood swings are not always extreme, Dr. Anand notes. For instance, some people experience a less severe form of mania, known as hypomania. Those who are hypomanic may not feel anything is wrong, making diagnosis more difficult, he adds.
Complicating matters is that it’s possible to experience both mania and depression at the same time, known as mixed features. When this happens, you may feel overly energized yet be extremely irritated, sad, hopeless, or empty.
Understanding and Managing Bipolar TriggersBipolar episodes can be triggered by lifestyle and environmental factors. Recognizing your triggers and avoiding them, Anand says, is often key to managing the condition.
Factors that may worsen bipolar symptoms or trigger an episode include:
- Stress In many cases, a major life change or stressful event, such as losing a loved one or having financial troubles, can trigger an initial episode.
How you cope with stress can also affect how your bipolar disorder progresses. According to a meta-analysis published in January 2017 in the Journal of Affective Disorders, people with bipolar disorder having a relapse of their condition reported experiencing more stressful life events compared with those who were in a more stable mood phase. The researchers concluded that individuals with bipolar disorder tend to be more “sensitive” to stressors, suggesting that psychosocial treatments are an important component of successfully managing your condition. (Psychosocial treatments include psychotherapy, support groups, and education on the disease for loved ones so they can assist with coping strategies and spot the signs of relapse, according to NAMI.) - Childbirth The link between childbirth and bipolar disorder has been well documented in a number of scientific studies. A systematic review of nine papers published in October 2016 in the journal BMC Pregnancy and Childbirth found that the risk for mood disorder episodes increases during pregnancy in the postpartum period in women with bipolar disorder.
In one of the studies included in the review, researchers found that nearly 50 percent of women with bipolar disorder experienced at least one mood episode during pregnancy or within 12 months after childbirth. It’s also worth noting that both men and women with bipolar disorder may be triggered by childbirth. While there is very limited research examining the effect of a new baby on fathers, a study published in May–June 2017 in American Journal of Lifestyle Medicine found that available evidence suggests fathers with bipolar disorder may have an increased risk of hypomanic episodes after the child is born. - Medication Treatment for bipolar disorder includes medications, such as mood stabilizers, antipsychotics, and antidepressants, according to NAMI. Interestingly, some antidepressants, such as Prozac (fluoxetine) and Zoloft (sertraline), may worsen bipolar symptoms and possibly even trigger a manic episode, Anand says, adding that if you have bipolar disorder, you should not take an antidepressant without also taking a mood stabilizer or antipsychoticmedication.
Stimulants used to treat attention deficit hyperactivity disorder (ADHD) may also trigger a manic episode. If you have more than one condition (such as obsessive-compulsive disorder or ADHD) that is treated with medication, NAMI recommends that you develop a treatment plan with your doctor to best manage both conditions and monitor your side effects. - Seasonal changes For some people with bipolar disorder, there’s a seasonal pattern to mood episodes. Anand says there’s some evidence that more manias occur during the spring and summer months, while more episodes of depression take place in the fall and winter. But some people experience the opposite. According to an Austrian study published in January 2019 in the Journal of Affective Disorders, which examined data on over 60,000 people who were admitted to a hospital for a manic, depressive, or mixed featured episode between 2001 and 2014, seasonal patterns in hospitalization rates during manic episodes were found for both men and women.
(Women were more likely to experience manic episodes in summer and autumn, depressive episodes in winter, and mixed features in summer, whereas men were more likely to experience manic episodes in summer.) Women under age 35 were also more likely to have this seasonal pattern in manic and mixed episodes. There may be a seasonal pattern to your shifts in mood because of changes in sleep, intensity of sunshine, and number of daylight hours, as well as changes in melatonin levels. Closely monitoring your symptoms during seasonal changes can help you manage your bipolar disorder. - Poor sleep Lack of sleep is a frequent trigger of bipolar mood episodes, according to Anand. Poor sleep or a disruption in normal sleeping patterns, including jet lag, can trigger these intense mood swings. But there is evidence that psychological treatment may help. In a study published in June 2015 in the Journal of Consulting and Clinical Psychology, researchers treated half of the 58 study participants who had bipolar disorder and insomnia with a bipolar-specific modified form of cognitive behavior therapy that involved incorporating good sleep habits, relaxation, and dim lights at bedtime and reducing anxiety about sleep into daily routines.
The other half of the study participants were given information about how sleep, stress, diet, exercise, and mood are related to each other but no plan or intervention designed to change behavior. The results were eye opening: Six months after these interventions, the people who received cognitive behavior therapy had experienced just 3.3 days in a bipolar episode compared with the 25.5 days experienced by those who were given only education materials. The cognitive behavior therapy group also had a lower rate of relapse and less severe insomnia. These results show that it may be beneficial for you to ask your doctor for a plan to ensure you’re getting enough quality sleep if you have bipolar disorder. - Drug and alcohol use According to NAMI, substance abuse is common among people with mental illness as a way to cope with their symptoms. In fact, 30 to 50 percent of people with bipolar disorder will develop a substance abuse disorder, notes the Substance Abuse and Mental Health Services Administration (SAMHSA).
Anand cautions against using drugs or alcohol to “treat” symptoms of the condition. Drinking or taking drugs, he says, can worsen your bipolar mood swings and lead to an increase in suicidal thoughts or behaviors. As SAMHSA notes, substance use or withdrawal can cause symptoms attributed to bipolar disorder, including agitation, anxiety, and paranoia. Drinking alcohol in particular can make you less likely to respond to treatment and more likely to be hospitalized. Try medication and psychosocial therapy instead. - Caffeine Caffeine is a stimulant. As such, it may trigger manic episodes, change sleeping patterns, and affect the way your body breaks down the medications you take to treat your condition, according to a review published in September 2020 in the journal Bipolar Disorders. Talk to your doctor about your caffeine consumption and how it may affect your symptoms.
While these culprits can lead to a bipolar episode, it’s also important to keep in mind that episodes can occur even without a trigger.
“Bipolar episodes can come out of the blue,” Anand notes. Do what you can to manage your stress, get good sleep, and avoid using alcohol or any other substance, and work with your doctor to find the best strategies for you to manage your bipolar disorder.
Additional Reporting by Jessica Migala
Triggers and Early Signs of Mania and Depression
Contents
Contents
Introduction: Bipolar Toolkit
Chapter 1. Graph and Mood Charts
Chapter 2.1. Your Wellness Plan
Chapter 2.2. Triggers and Early Signs of Depression and Mania
Chapter 3 Treatment Agreement
Common Triggers of Depression
- Alcohol or Drugs
- Change of Seasons
- Relationship breakdown
- Job loss
- Another negative life event
- Conflicts with others
- Stopping medication
- Lack of physical activity
- Unhealthy diet.
In particular, lack of vitamin B and folic acid, or consumption of large amounts of sweets
- Social isolation
- Negative way of thinking: self-criticism, self-blame
- Physical illness. It can be a severe and long-term illness, chronic pain, but it can also be a common flu
- provocation of depressive mood with sad and difficult books, music, communication with negatively configured people
- the pressure of the mental illness
- nightmares, heavy dreams
Typical triggers of mania
- lack of sleep
- seasons change - change of seasons - change of seasons - change of seasons - change of seasons - change of seasons - change of seasons - change
- Alcohol, drugs
- Stimulant drugs, such as antidepressants
- Some traditional treatments, such as St. John's wort
- Stress at school or work
- Money problems
- Travel, especially jet lag mood
- Starting or stopping smoking
- Breaking up a relationship
- Gambling activities, such as online games, internet chats, cards, stock trading
- Some hormonal diseases, in particular diabetes, thyroid disease
- Unsuitable diet, especially excess sweets, caffeine.
Early signs of mania and hypomania
- the need for a dream
is reduced - more thoughts and ideas
- the well -being of
- an increase in energy
- increased irritability
- the color seemingly: color seem brighter, music, music more expressive
- Increased sexual arousal
- Change in sexual behavior. People who were not noticed before begin to seem attractive, interest in types of sex that are unusual for you
- Desire to take risks
- Feeling invulnerable, endowed with special powers and abilities
- Impatience, inability to wait, annoyance at the "slowness" of others
- Jumping from thought to thought
- Feeling of love
-
to everyone around, but exactly as long as they do not start to object to you- Unusual sociability, desire to talk with random people you meet
- Talkativeness
- Impulse buying
- Interest in risky financial affairs, questionable investments
- Paranoid thoughts, feeling that people are discussing, criticizing, persecuting you affairs, ambitious projects
Early signs of depression
- Avoiding people, not wanting to go to meetings
- You quit the things you normally do: exercising, walking the dog, going to church, reading books, dating, playing games with children
- You don't leave the house, even if you have something important to do: go to the store, the post office, the bank .
You have difficulty falling asleep, you sleep longer, you want to sleep during the day
- Changing your diet. You don't want to eat, or you eat more than usual, especially "junk food"
- Stop paying attention to your appearance, hygiene.
– Self-care seems harder
- you feel hopelessly
- you are sad, you are suppressed by
,- you feel guilty
,- you lose interest in sex
,- become irritable
- feel anxiety
- insensibility
- lack of motivation 9000,
- loss of interest to the environment
- Things you used to like no longer bring you joy
- Thinking is slow and difficult
- You find it difficult to concentrate
- You are critical of yourself, you blame yourself
- You find it difficult to make decisions
- You have many anxious thoughts
- Obsessive thoughts
- Thoughts of self-harm
- Negative thoughts about others, about your future
Strategies for wellness
- Regular adequate sleep
- Selection of suitable drugs
- Psychotherapy in addition to drugs
- Regular consultations with a psychiatrist
- At the first signs of an episode, immediately make an appointment with a doctor, strictly follow the doctor's recommendations that have already caused you seizures in the past
- Stable daily routine
- Regular and good quality meals.
Important: enough protein, minimum of simple carbohydrates and animal fat, enough omega-3 acids (fish oil), vitamin B12, folic acid
Daily exercise that brings you pleasure
Avoid overstimulation, overly stimulating environments
Maintain health, treat co-morbidities such as thyroid disease and diabetes
Learn and use healthy thinking techniques: reality testing, self-support.
Sample Recovery Plan
| Trigger | Early Signs | Wellness Strategy |
| Time Zone Change | Use sleeping pills to help you fall asleep on time. Use additional mood stabilizers. | |
| Sleep interruption | Difficulty falling asleep | Use sleeping pills until sleep is restored. More exercise. |
| Stress due to work, problems in personal life, money | Increased irritability, paranoid thoughts, tendency to argue and conflict | More physical activity. Proper diet. Take a "reality test" with the help of a loved one. |
| Stress due to work, problems in personal life, money | Impulsive, extravagant purchases | Entrust shopping to your spouse. Avoid online shopping, do not carry credit cards with you. |
Read more Treatment agreement or crisis plan
symptoms of bipolar disorder, how it goes, how to find a psychiatrist, diagnosis and treatment
Victoria K.
lives with bipolar disorder
The first signs of the disease appeared in my teens, and the psychiatrist diagnosed bipolar disorder at the age of 26.
According to WHO, 45 million people worldwide suffer from bipolar disorder. This disease greatly reduces the quality of life: in some periods you are overly energetic and do things that you can regret, in other periods you are not able to get off the couch to do everyday things. nine0006
I will tell you how I have BAD and what I do to cope with the disorder and live like all ordinary people.
Go see a doctor
Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you. nine0006
What is Bipolar Affective Disorder?
Bipolar Affective Disorder, or BAD, is a mental disorder with alternating emotional ups and downs in mood. It is affective just because it is associated with violations of the emotional state, that is, mood - in psychiatry, the manifestation and experience of emotions is called affect. Previously, this disease was called manic-depressive psychosis.
Bipolar Disorders - A Physician's Handbook MSD
Why BAD develops is not exactly known. Among the reasons are heredity, traumatic events, violations of the production of neurotransmitters - substances due to which signals are transmitted between brain neurons.
The disease often manifests itself in adolescence or in the period between 20 and 30 years.
How bipolar affective disorder manifests itself
BAD usually begins abruptly, followed by periods without signs of illness and periods of exacerbations. The peculiarity of the disease is that during periods of exacerbations there are episodes, or phases, with different emotional states that can replace each other in an arbitrary order. nine0006
Bipolar Disorder - Mayo Clinic Blog Article
For example, when the illness escalates, the following conditions may occur.
Mania - a state of elevated or irritable mood. The person feels energetic, actively engaged in something, such as finding a new hobby or even trying to open a business. As a rule, he sleeps little, is self-confident, talkative, he has a lot of ideas, often crazy. Risk sensitivity may decrease - for example, a person invests all the money in a hopeless business or gets into a loan.
Hobbies for gambling, extreme sports are not uncommon. At the same time, a person feels great, but often cannot concentrate on one thing, work productively. nine0006
The extreme degree of mania is manic psychosis, when delusions of persecution, hallucinations, excessive activity develop, a person can become dangerous to himself or others.
Hypomania is a kind of mild mania. A person is in a state of emotional uplift, but this uplift is not so pronounced. However, the mood still improves, the need for sleep decreases, the person is creative, relaxed, feels euphoric, and his productivity increases. Although in some people such periods may be accompanied by irritability and a decrease in concentration. nine0006
Depression - low mood, loss of interest in life, fatigue, guilt, indecision, decreased concentration. Sleep and appetite disturbances may occur. Sometimes there are thoughts of suicide, the futility of one's own life.
/bye-depression/
“It reminded me of a strict regime sanatorium”: how much I spent on treating depression
Between exacerbations, a person can return to normal, although it happens that his performance is still reduced.
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Manifestations of the phases of bipolar disorder, according to the National Institute of Mental Health USA
| Parameter | Mania | Depression |
|---|---|---|
| Mood | Excitement, joy, irritability, resentment | Sadness, depression, emptiness, anxiety, hopelessness |
| Sleep | Reduced need for sleep | Trouble falling asleep, getting up early or sleeping too much |
| Appetite | Loss of appetite | Often increased appetite, weight gain |
| Communication | Talkativeness | Slow speech, forgetfulness |
| Concentration | Feeling of jumping thoughts, multitasking | Problems with attention and decision making, distraction |
| Behavior | Risk appetite, runaway spending, promiscuous sex | Lack of pleasure and interest in anything, decreased libido |
| Subjective feelings | Feeling of self-importance, talent and power | Feelings of worthlessness, suicidal thoughts, suicide attempts |
Mood
Excitement, joy, irritability, resentment
Sleep
Decreased need for sleep
Appetite
Loss of appetite
Communication
Talking
Concentration
Feeling of thoughts, multitasking
behavior
risk, unbridled sex
Subjective sensations
,Feeling of own importance, talent and power
Depression ,0006 Mood
Sadness, depression, emptiness, anxiety, hopelessness
Sleep
Trouble falling asleep, getting up early or sleeping too much
6Appetite
often increased appetite, weight gain
,Communication
Slow speech, forgetfulness
Concentration
Problems with attention and making decisions, Disperionity
behavior
Lack of pleasure and interest in something, decrease in libido
Subjective feelings
Feelings of worthlessness, suicidal thoughts, suicide attempts
There are two main types of bipolar disorder according to how the disease manifests itself:
- When there was at least one manic episode and depressive episodes recur.
- When there are periods of depression and at least one episode of hypomania, but without full mania.
Bipolar Disorder - National Institute of Mental Health USA
I just have bipolar affective disorder type 2. This means that there are no full-fledged manias, but there are hypomanias and severe depressions.
Hypomania is a very cool time for me. You can do everything: get a second degree, run a marathon, learn English, go on an unplanned trip. And so for several months during which you do not sleep, do not eat, acquire new friends, start novels, end old relationships. You feel all sensations in the maximum range. During the day, it can throw several times from tears and the desire to die to incredible happiness. nine0006 This is what mania looks like in BAD. Source: Twitter
After hypomania comes depression. And immediately there is not enough strength not only for what was started during the previous phase, but also for ordinary things. The most understandable image of depression for me is “pressed down by a concrete slab.
” It becomes hard to do the simplest things: wash the dishes, change clothes, go to the store.
Unfortunately, the brighter the hypomania goes, the worse the depression gets later — that's why, with experience, I stopped enjoying the active phase. nine0490 Now it is even more difficult for me: I understand what is happening with my brain, but I cannot control it.
As I remember now, my first hypomania happened at the age of 12. Then there were periods of exacerbations clearly in a year and a half: hypomania lasts 2-3 months, usually May - July, depression - 5-6 months, usually in October - March, in between remission occurs when I feel normal. If I am in a long-term remission, then I hardly notice phase changes: mood swings are smoothed out with the help of medications or psychotherapy. nine0006
10 podcasts about health and medicine
The usual course of bipolar affective disorder
Viktor Lebedev
psychiatrist, science journalist
During an exacerbation of bipolar disorder, episodes of mania or hypomania and depression may alternate.
There is a clear separation of phases: first a hypomanic or manic episode, then a depressive episode, it happens that there are recurring episodes of depression, then hypomania. In the latter case, hypomanic phases are sometimes not noticed, a person may be diagnosed with recurrent, that is, recurring depression, and may be prescribed the wrong treatment. nine0006
In fact, in BAD, the phases can alternate in any order, the diagnosis is made if there is any combination of manic and depressive episodes. The first time the disease usually begins with an episode of mania or hypomania, which develops into depression. Less commonly, it starts with depression, then mania or hypomania occurs. But in any case, there must be affective disturbances, that is, mood disturbances.
The exacerbation of the disease lasts from several weeks to several months. This also depends on whether the person is receiving medical treatment. If you respond quickly to an exacerbation, you can sometimes return to normal health in a week.
If not treated, the exacerbation can last for several months - especially the depressive phases, episodes of hypomania and mania usually pass faster. nine0006
Seasonality of phases, when there is a connection between the manifestations of the disease and the change of seasons, occurs, but not all patients with bipolar disorder notice it.
How I suspected I had BAD
The first time I thought I was going crazy was when I was 18 years old. Painful relationships ended, obsessive thoughts and images swirled in my head, I listened to the same song in the player, walked for hours and could not stop. This went on for so long and was so unbearable that I almost decided to go to a psychiatrist. However, they didn’t talk about mental disorders then, so I didn’t even know where to turn. Then this state passed by itself. nine0006
I did not see a psychiatrist until seven years later, when I again had a similar severe condition: obsessive thoughts, inability to control emotions, self-harm, sleep and appetite disturbances.
Before that, I had three episodes of hypomania every two years, but after them there was no severe depression, and therefore no reason to seek help.
Then I just went to the district polyclinic - it turned out that a psychotherapist was there. She checked my symptoms on the Beck scale, diagnosed me with an anxiety-depressive disorder, and prescribed a common antidepressant that is often prescribed for depression. nine0006
Beck Depression Scale - online test
It seemed to me that antidepressants helped me immediately: my mood improved, I got energy, I talked a lot with friends, hung out, worked. Now I know this is a bad sign. Antidepressants usually take a long time to work: it takes about three weeks for the effect to appear, and I got better after a few days. In addition, in bipolar affective disorder, antidepressants can cause hypomania if not mitigated by other drugs. nine0006 This meme is well understood by those who were not immediately given the correct diagnosis.
If you add Mentos to Coca-Cola, you get a foamy fountain that will splash out of the bottle. Antidepressants, in particular SSRIs - selective serotonin reuptake inhibitors - have the same effect on the mood of people with BAD
I went to this psychotherapist several more times, but she did not track my sharp mood swings, and I had one of the most severe hypomanias . I drank and smoked a lot, I had incredible emotional swings, I ruined my relationship with my best friend, I stopped eating and sleeping. nine0006
After a couple of months my condition stabilized a little, but I continued to take antidepressants: I knew that they should not be stopped abruptly. Before canceling, I went for a consultation with another doctor, already at a paid clinic. She turned out to be a good specialist: she asked questions about mood swings, found out if I had previously had mood swings, ups and downs, depressions. Then everything was fine because of taking antidepressants, so I denied everything.
A year later, as the doctor prescribed, I smoothly stopped taking antidepressants, and a few months later I was overcome by one of the most severe depressions.
If last time I could attribute depression to circumstances - burnout, relationship difficulties, fatigue - now there was no reason for it. I had a job I loved, a great relationship with my husband, financial stability, a new city. And I wanted to die. nine0006
/psychotherapy-search/
How to choose a psychotherapist
This moment became a turning point in the diagnosis. I already knew that there is such a disease as bipolar affective disorder, what are its symptoms and features. Information about BAR appeared in the media field: I read articles and blog posts, watched videos on YouTube.
I was able to describe the last 10 years of my life in phases: there was a strong rise, followed by a decline. For example, in the hypomania of 2012, I worked two jobs, passed the state exams, wrote a diploma, hung out with friends until the middle of the night and completely took care of the life of the family. In hypomania in 2014, she entered the magistracy, graduated from a driving school, traveled, and also ran a marathon.
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Every upswing was followed by a downswing: I stopped running, didn't pass the exam in the traffic police, dropped out of the master's program. Each such exacerbation generally lasts a year and a half, and then repeats.
How I searched for a suitable psychiatrist
After collecting information about BAD, I decided to find a psychiatrist to confirm or deny my diagnosis. It didn't happen right away.
First I went to a psychiatrist on the advice of a friend, he helped her with depression. The doctor saw me in a paid clinic, the appointment cost about 3000 R. The consultation was unsuccessful: the doctor was clearly not interested in my condition, he indifferently asked questions about depression and prescribed antidepressants. And not the ones that were assigned to me last time, but others. I was too depressed to stand my ground, so I just started looking for another doctor. nine0006
6 useful services for finding a psychotherapist
The second doctor was in a state clinic, she was recommended to me on Facebook.
At first, I waited a long time for an appointment - the doctor was half an hour late, then I started asking about birth injuries and vascular dystonia. This consultation didn't work for me either. I paid 2,000 rubles for her.
The third appointment was successful: I found a psychiatrist, whom I still go to. She works at the State Institute of Psychiatry, but I see her for a fee. One consultation costs 2500 R.
2500 Р
I pay a psychiatrist for one appointment
The institute where the doctor sees, I was advised somewhere in the comments on the Internet. I called the reception and asked to sign me up for a doctor specializing in affective disorders as soon as possible.
The search for a suitable psychiatrist took about a month, so I went to see a doctor in a completely crushed state, in tears and hysteria. The psychiatrist asked me about the illness, listened to me and offered free hospitalization. However, I refused: I felt that I was controlling myself so as not to commit suicide, and my husband was also nearby, who understood the seriousness of the situation.
As a result, I continued the treatment at home. nine0006
When hospitalization is needed for bipolar disorder
Viktor Lebedev
psychiatrist, science journalist
Hospitalization for bipolar affective disorder may be necessary if during a manic episode the patient develops strong arousal, he completely loses a critical attitude to his condition, and hallucinations appear rave. Such a condition can end badly for the patient himself or his relatives. In a depressive episode, indications for hospitalization will be suicidal thoughts or suicide attempts. nine0006
Inpatient treatment may also be needed in case of a severe decrease in working capacity.
If you suspect you have bipolar disorder, but are not in the acute phase of the disease, help is not urgent, it is better to spend time looking for a psychiatrist who specializes in bipolar disorder or affective disorders in general. Such a doctor is likely to quickly make the correct diagnosis and select the best treatment.
Before taking, it is worth writing down all the symptoms that bother you, and also, if possible, make a retrospective graph of the expected phases - mania and depression, write down when they occurred and how long they lasted. This will help the doctor understand if this is BAD or something else. nine0006 This is how the BAR phase sequence looks like in my case
BAD treatment
Consultations with a psychiatrist and drug therapyThe psychiatrist first wrote me a prescription for several drugs: antidepressants and mood stabilizers. They are usually prescribed to people with affective disorders.
As I was told, treatment is, among other things, a test for the correctness of the diagnosis, a way to distinguish depression from bipolar disorder. If the prescribed drugs help, the diagnosis is correct. nine0490 About two months later, my diagnosis was officially confirmed: bipolar affective disorder type 2.
How bipolar disorder is diagnosed
Viktor Lebedev
psychiatrist, science journalist
Bipolar affective disorder is diagnosed by the problems that bother a person.
His story should contain a description of typical mood and behavioral disorders, usually there is an alternation of phases of the disease.
For diagnosis, complaints and a history of the disease are enough, sometimes the testimonies of relatives are also taken into account, which can tell about a person's behavior. It happens that a doctor can send you to a clinical psychologist for a psychological examination, but usually an ordinary psychodiagnostic conversation is enough. nine0006
You can suspect the disease on your own, although with hypomania or mania, criticality to one's condition often decreases, that is, a person does not understand that something is wrong with him. Sometimes relatives of the patient come for help, and not he himself. It is better to apply for a diagnosis to a specialist who has worked with BAD, knows what the manifestations of the disease look like.
In general, drug therapy for bipolar disorder consists of several types of drugs that relieve different manifestations of the disease.
These are normotimics that stabilize mood, antidepressants that help to cope with depression, antipsychotics that relieve excessive arousal. nine0006
Medication for Bipolar Disorders - MSD Handbook
Bipolar Disorder in Adults: Choice of Therapy - Article for Physicians Uptodate
The doctor selects the type of medication and dosage based on the phase the patient is in. Antidepressants are usually used in depressive phases and in combination with mood stabilizers. Antipsychotics - only in manic episodes and also together with normotimics.
In severe cases, a person with bipolar disorder may take up to six different drugs. But you need to strive to get by with one or two. nine0006
I started taking prescribed antidepressants and mood stabilizers immediately after seeing a psychiatrist. This time, the process of getting out of depression was long and smooth.
How therapy is selected for bipolar affective disorder
Viktor Lebedev
psychiatrist, scientific journalist
The psychiatrist selects treatment individually, taking into account the clinical picture: in the depressive phase - some drugs, in the hypomanic phase - others, in mania - still others.
It is important to combine drugs correctly. So, if a patient with bipolar disorder is prescribed only antidepressants, this can worsen the situation, even if he is depressed. Antidepressants can "disperse" his condition to hypomania or even mania. It is necessary to normalize a person’s well-being, and not throw him into a state with the opposite sign, so therapy includes normotimics. nine0006
The fact is that depression in BAD is not the same depression as usual, they are not always similar even in external manifestations, there are differences from a biological point of view, that is, in how processes in the brain change.
I visit my psychiatrist regularly: she adjusts the doses of drugs and monitors my condition. In the first year, I visited her six times - it cost me 15,000 R. Now I go to the doctor only during an exacerbation or a presumptive phase change - about four times a year, once every three to four months. It costs 10,000 R per year. In total, I have been seeing a doctor for three years now.
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For two years, until recently, I took antidepressants and mood stabilizers in the minimum dosage. A pack of antidepressants for a month cost about 400 R, mood stabilizers - 600 R. That is, during the period of remission, the pills took 1000 R per month.
1000 R
I spend on pills a month in remission
My prescriptions for drugsHowever, a few months ago I had an exacerbation, I went into hypomania, so the regimen and dose of drugs had to be changed on the go. Within two weeks, my psychiatrist and I canceled antidepressants, significantly increased the dose of mood stabilizers - 2.5 times, and added antipsychotics. During the exacerbation, which lasted two months, 4000 R per month was spent on tablets. Now 2000 R will go away - the dose of mood stabilizers has been reduced by one and a half times and neuroleptics by half, antidepressants have been removed. nine0006
It is interesting to observe how quickly drug therapy changes the state of the body and how it then returns to normal.
Often, drugs do not fit the first time, so you need to regularly visit a psychiatrist and monitor your well-being. But after choosing the right therapy, you can live almost as before, except that you need to be more attentive to yourself.
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BAD treatment cannot be found once and for all
Each patient who is responsible for the treatment of bipolar disorder and is in contact with the doctor has his own scheme for changing the dosage or types of medications, taking into account well-being. For example, if you cannot sleep for more than a few days and stop eating, you add an antipsychotic. If you fall into an abyss of self-hatred and don’t swim for more than a week, an antidepressant will help.
Of course, this does not cancel regular meetings with a psychiatrist, because the process of choosing drugs and dosages is very complicated. Now I can regulate a lot myself, depending on how I feel, but I still see a specialist.
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At the same time, bipolar affective disorder cannot be cured once and for all - you can only go into a long remission. As my doctor told me, this is five years without pronounced phases. In my case, I lasted two years without episodes, and now I need to start the countdown again.
Also, as far as I know from my experience and the experience of people with the same diagnosis, at some point there is an illusion that everything is cool, there is no illness, it seemed to you that you are doing great. At this point, people stop taking pills - this is a bad decision, never do this. If you feel good, first of all, you should check if this is the beginning of hypomania. And secondly, be glad that you have entered remission. nine0006
During these three years, I once stopped drinking pills - depression occurred, once I did not pay attention to the symptoms - I got severe hypomania, now I am trying to go into remission again.
BAD treatment
Psychotherapy The effectiveness of the treatment of bipolar affective disorder can be increased by combining drug therapy with psychotherapy.
Cognitive behavioral therapy is often used for bipolar disorder. It teaches you how to cope with stress factors, monitor your condition, manage the symptoms of the disease. Even during the sessions, together with the doctor, they work out trigger situations, that is, what can provoke an exacerbation of the disease. nine0006
Bipolar affective disorder and supportive psychotherapies - article on the Uptodate physician website
For example, I have trouble admitting my own mistakes. Every mistake for me is a tragedy, and it seems to me that those around her will never forget. It is difficult for me to admit my own mistakes, oversights cause great anxiety. I also have an ideal image of what I should be: read a lot, earn money, keep my house perfectly clean, have six-packs, study, know two foreign languages, go to exhibitions. Obviously, this is impossible, but a persistent desire to reach an unattainable height is also stressful. I work through all this with a psychotherapist. nine0006
I started therapy only six months ago, on the advice of a doctor, before that I thought that I could cope on my own.
At first she was in therapy with a psychotherapist, whom she found through the Inhale project, which helps burnt out employees from the charitable field. I worked with her on this project, then continued after completion.
We looked at situations that increase my anxiety, including fear of making mistakes and being judged, as well as difficulties in life in general. The cost within the project was 400 R per meeting, there were about ten of them in total, then, already outside the project, the price increased to 2400 R.
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Now I went to another psychotherapist - she has a more applied approach, we look for my cognitive distortions and try to remove them. For example, we work with my excessive anxiety about the impression I make on other people, and the fear that I cannot control it.
The cost of sessions with this specialist is 2500 R per visit. Now I go to her every 10-14 days, that is, 2-3 times a month.
In general, I have been working with my condition on my own for quite a long time, so the therapist only directs me in the right direction. nine0006
Is psychotherapy mandatory for bipolar disorder
Viktor Lebedev
psychiatrist, science journalist
Cognitive behavioral therapy is most commonly prescribed for bipolar disorder. This is an optional therapy, that is, an auxiliary method of treatment, you only need to take medication. However, psychotherapy can greatly improve the quality of life: it complements the action of drugs well, helps to control and change those things that pills do not work on. First of all, cognitive-behavioral therapy helps to control emotions, better cope with your illness. nine0006
Many also benefit from support groups for people with bipolar disorder. I tried to go to such a meeting, but it didn’t work for me: I don’t want to define myself through illness, this is part of my life - but not me.
The largest project holding such meetings is Sunday BAR.
They support not only people with bipolar disorder, but also their loved ones. Meetings are held online and offline.
List of support groups in different cities for people with BAD and other disordersPDF, 275 KB
BAD treatment
LifestyleUniversal advice given for bipolar disorder and beyond includes the following recommendations: maintain sleep and work-life balance, eat right, do not drink alcohol, play sports.
All this really helps, but in fact, organizing your life is difficult: meetings with friends, vacations, unexpected work do not fit into the routine, you want to work more, and alcohol looks like a great way to cope with anxiety, although in fact it can lead to depression. nine0006
I try to keep the correct regimen to the best of my ability. True, according to my feelings, depression comes by itself, without any triggers from the outside, and I cannot influence it. But hypomania is fueled by new projects, loves, and other emotions.
For example, even a small amount of falling in love causes hypomania, which, in turn, increases falling in love. It doesn't end well.
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I lived in St. Petersburg for quite a long time, where during the white nights you don't feel like sleeping at all - and this provokes hypomania. One of the psychiatrists even forbade me to go to St. Petersburg for some time.
Now I have an established sleep and food regimen, I quickly notice its violation - this is a signal that an exacerbation has begun. Unfortunately, sometimes the regime is knocked down by external circumstances, then it is more difficult to notice the exacerbation of BAD.
Sleep is very important to me, it is my priority. I try not to hang out until the middle of the night, and if I didn’t manage to get enough sleep, then I try to sleep in the afternoon. I usually go to bed around midnight, get up at 8-9hours of the morning is a comfortable mode for me and my work.
I very rarely stay awake at night or wake up later than 10 am.
I have a fitness bracelet that tracks the phases and amount of sleep - it helps to see the dynamics and notice deviations. When I see a sleep disorder, I start drinking light tranquilizers and antipsychotics to return to a comfortable mode.
| Sleeping less than seven hours on pills indicates an episode of hypomania, without drugs in this phase I would sleep less than four hours | And sleep for more than seven hours is already the normalization of the state after the addition of other tablets |
My psychiatrist believes that first sleep, and then everything else, and my experience confirms this: sleep disturbances have a stronger effect on well-being. I also keep a record of alcohol consumption in the Alcogram application - abuse negatively affects my condition. When I see how many sober days there were, it motivates me to control myself. nine0006 I am lucky in that I take my job seriously: it is responsible and resource-intensive, it is important for me to be productive, it disciplines and helps me to keep the regime.
What to do to reduce the frequency of exacerbations
Viktor Lebedev
psychiatrist, science journalist
In BAD, it is important to have a daily routine that allows you to maintain normal behavior. This reduces the frequency of exacerbations, sometimes helps to completely avoid the recurrence of episodes of the disease. In addition to quality sleep and proper nutrition, you need to avoid overwork, work in an exhausted state, give yourself a rest.
Doctors usually insist on the exclusion of alcohol, drugs are also dangerous, especially stimulants, which can cause psychosis in a healthy person. nine0006
Exacerbations of the disease can occur on their own, without the influence of external factors, or they can be caused by external events, both tragic, such as the death of a loved one or a break in relationships, and joyful. Therefore, it is important to learn to recognize your emotions, to identify in time what provokes a new episode, both independently and with the help of psychotherapy.
How I live with BAD now
Accepting the diagnosis was not easy: on the one hand, it finally became clear what was happening to me and that it could be regulated. On the other hand, this is a diagnosis for life. You need to constantly monitor your condition, take pills, consult with doctors. nine0006
The most difficult thing for me was the inability to separate myself as a person from the disease. What of what I did in life was the result of my choice, and what was a symptom of the disease? Moving from city to city, changing jobs, partners, hobbies - what if all this is just a disease, and I'm not behind it? Three years have passed - and I still cannot separate myself from BAD, it seems impossible.
Now life has become easier: now I know what to expect in the near future, because the phase schedule is still respected. It is clear when to slow down with the pace of life, and when to add antidepressants. nine0006
My work is related to people. Of course, the disease affects my mood and state: in depression I have less strength and the ability to give out emotions, in hypomania, on the contrary, there are a lot of emotions, but there is not enough concentration. It's good that work allows you to vary the load depending on the phase: in depression I can work a little less, and in hypomania - a little more.
At the time of my first diagnosed depression, I had an unloved job, it took the entire resource. I cried in the mornings, afternoons and evenings because it was difficult for me to keep working. Now I really love my job, it gives me more resources than it takes. nine0006
I continue to take medication, see a psychiatrist several times a year and a psychotherapist several times a month.
In March, at the most difficult moment of the exacerbation, I spent on medicines, an appointment with a psychiatrist and three meetings with a psychologist 13,000 R.
13,000 R
I go into remission and spend about 8,000-10,000 R per month on medications, a psychologist, and periodic appointments with a psychiatrist. A significant amount, but it allows me to remain in a resourceful and efficient state. nine0006
The unobvious difficulty of living with bipolar disorder is the need to strictly control one's financial situation. In hypomania, money flies away easily, you make decisions instantly - for example, you can decide in a minute to fly to Spain and buy tickets. When you are depressed, you spend less, but it is also difficult to earn money. I try to keep a financial cushion in case of an aggravation, and also take into account all expenses in the application so as not to get into debt. Fortunately, so far my financial anxiety is stronger than bipolar, so there has never been a credit card debt.
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I spent 58,800 rubles on BAD treatment in a year
| Treatment | Price |
|---|---|
| Psychiatric appointment | 10 000 R, total 4 receptions of 2500 R |
| Psychotherapist appointment | 25 000 R, total 10 receptions of 2500 R |
| Antidepressants | 4800 R, 12 packs of 400 R |
| Antipsychotics | 7000 R, 7 packs of 1000 R |
| Normotimics | 12000 R, 15 packs of 800 R |
Reception of a psychiatrist
10 000 R, total 4 receptions of 2500 r
Reception of a psychotherapist
25,000 r, total 10 doses of 2500 r
antidepressants
4800 r, 12 packages of 400 p
9000neuroleptic neuroleptic
7000 R, 7 packs of 1000 R
Normotimics
12000 R, 15 packs of 800 R
Books I recommend reading about bipolar affective disorder
The most famous book about living with bipolar disorder is The Restless Mind.
